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Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly

Saliva as a diagnostic tool is patient friendly and offers analytical advantages. Hormonal analysis of saliva is not influenced by changes in concentrations of binding globulins as the free concentration of the hormones is measured. Analysis of salivary cortisol is common practice in the diagnostic...

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Autores principales: Langelaan, Marloes L P, Kisters, Jérôme M H, Oosterwerff, Mirjam M, Boer, Arjen-Kars
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890080/
https://www.ncbi.nlm.nih.gov/pubmed/29531158
http://dx.doi.org/10.1530/EC-18-0085
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author Langelaan, Marloes L P
Kisters, Jérôme M H
Oosterwerff, Mirjam M
Boer, Arjen-Kars
author_facet Langelaan, Marloes L P
Kisters, Jérôme M H
Oosterwerff, Mirjam M
Boer, Arjen-Kars
author_sort Langelaan, Marloes L P
collection PubMed
description Saliva as a diagnostic tool is patient friendly and offers analytical advantages. Hormonal analysis of saliva is not influenced by changes in concentrations of binding globulins as the free concentration of the hormones is measured. Analysis of salivary cortisol is common practice in the diagnostic work-up of hypercortisolism. We investigated the potential role of measuring salivary cortisol when adrenal insufficiency (AI) is suspected, to reduce the numbers of ACTH stimulation tests. Over a period of 6 years, patients undergoing an ACTH stimulation test (tetracosactide, 250 µg) in our hospital were included. Plasma cortisol (Elecsys, Cobas, Roche Diagnostics) and salivary cortisol and cortisone (LC–MS/MS) were determined at t = 0, 30 and 60 min after stimulation. Based on peak plasma cortisol levels, AI was ruled out in 113 patients and was established in 16 patients. Patients without AI displayed maximal salivary cortisol concentrations of 12.6–123.4 nmol/L (95th percentile) after stimulation, as opposed to 0.5–15.2 nmol/L in AI patients. At t = 0 min, a minimal salivary cortisol concentration of 1.0 nmol/L was observed in patients without AI, whereas AI patients had a maximum concentration of 5.9 nmol/L. Using these cut-off values, 34% of the initial patient group could be diagnosed without an ACTH stimulation test (28% >5.9 nmol/L, 6% <1.0 nmol/L). A novel diagnostic algorithm, including early morning salivary cortisol analysis can reduce the numbers of ACTH stimulation tests in patients suspected of AI. This patient-friendly method can thereby reduce total health care costs.
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spelling pubmed-58900802018-04-11 Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly Langelaan, Marloes L P Kisters, Jérôme M H Oosterwerff, Mirjam M Boer, Arjen-Kars Endocr Connect Research Saliva as a diagnostic tool is patient friendly and offers analytical advantages. Hormonal analysis of saliva is not influenced by changes in concentrations of binding globulins as the free concentration of the hormones is measured. Analysis of salivary cortisol is common practice in the diagnostic work-up of hypercortisolism. We investigated the potential role of measuring salivary cortisol when adrenal insufficiency (AI) is suspected, to reduce the numbers of ACTH stimulation tests. Over a period of 6 years, patients undergoing an ACTH stimulation test (tetracosactide, 250 µg) in our hospital were included. Plasma cortisol (Elecsys, Cobas, Roche Diagnostics) and salivary cortisol and cortisone (LC–MS/MS) were determined at t = 0, 30 and 60 min after stimulation. Based on peak plasma cortisol levels, AI was ruled out in 113 patients and was established in 16 patients. Patients without AI displayed maximal salivary cortisol concentrations of 12.6–123.4 nmol/L (95th percentile) after stimulation, as opposed to 0.5–15.2 nmol/L in AI patients. At t = 0 min, a minimal salivary cortisol concentration of 1.0 nmol/L was observed in patients without AI, whereas AI patients had a maximum concentration of 5.9 nmol/L. Using these cut-off values, 34% of the initial patient group could be diagnosed without an ACTH stimulation test (28% >5.9 nmol/L, 6% <1.0 nmol/L). A novel diagnostic algorithm, including early morning salivary cortisol analysis can reduce the numbers of ACTH stimulation tests in patients suspected of AI. This patient-friendly method can thereby reduce total health care costs. Bioscientifica Ltd 2018-03-12 /pmc/articles/PMC5890080/ /pubmed/29531158 http://dx.doi.org/10.1530/EC-18-0085 Text en © 2018 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Research
Langelaan, Marloes L P
Kisters, Jérôme M H
Oosterwerff, Mirjam M
Boer, Arjen-Kars
Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
title Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
title_full Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
title_fullStr Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
title_full_unstemmed Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
title_short Salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
title_sort salivary cortisol in the diagnosis of adrenal insufficiency: cost efficient and patient friendly
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890080/
https://www.ncbi.nlm.nih.gov/pubmed/29531158
http://dx.doi.org/10.1530/EC-18-0085
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